When you or a loved one is coping with Parkinson’s disease, the drug choice can feel like navigating a maze. Eldepryl (generic name Selegiline is a selective MAO‑B inhibitor) is one of the oldest options on the shelf, but newer agents like rasagiline and safinamide often get the spotlight. This guide breaks down how Eldepryl stacks up against the most common alternatives, so you can see the trade‑offs in mechanism, dosing, side‑effects, cost, and real‑world use.
Key Takeaways
- Eldepryl works by preventing dopamine breakdown, making it useful early in the disease or as an add‑on to levodopa.
- Rasagiline offers a similar MAO‑B profile but with once‑daily dosing and a slightly better side‑effect tolerance.
- Safinamide combines MAO‑B inhibition with glutamate modulation, which can help with motor fluctuations.
- Levodopa/Carbidopa remains the most potent symptom‑control option, but long‑term use can lead to dyskinesias.
- Cost varies widely across the UK: generic selegiline is cheapest, while brand‑name safinamide carries a higher price tag.
What Is Eldepryl (Selegiline)?
Approved in the UK in 1970, Eldepryl is a MAO‑B inhibitor that blocks the enzyme monoamine oxidase‑B, which normally breaks down dopamine in the brain. By preserving dopamine, it helps smooth out the motor symptoms that characterize Parkinson’s disease. The drug is usually prescribed in two contexts:
- Early‑stage monotherapy: for patients whose symptoms are mild enough that levodopa isn’t needed yet.
- Add‑on therapy: combined with levodopa to reduce “off” periods and lower the levodopa dose.
Typical oral doses start at 5mg daily, titrating up to 10mg once the patient tolerates it.
Top Alternatives to Eldepryl
Three other agents dominate the Parkinson’s pharmacopoeia today. They differ in how they target dopamine, dosing convenience, and side‑effect profile.
Rasagiline (Azilect)
Like selegiline, rasagiline is a selective MAO‑B inhibitor, but it’s a newer molecule (approved in 2006) and comes in a convenient 1mg tablet taken once daily. Clinical trials (e.g., the ADAGIO study) suggest a modest disease‑modifying effect, though this remains debated.
Safinamide (Xadago)
Safinamide adds a twist: beyond MAO‑B inhibition, it modulates glutamate release, potentially reducing excitotoxic damage. Approved in 2015, it’s taken at 100mg once daily (after a 50mg titration week). It’s especially popular for patients who still experience motor fluctuations despite levodopa/rasagiline.
Levodopa/Carbidopa (Sinemet)
Although not an MAO‑B inhibitor, levodopa combined with carbidopa is the gold‑standard for symptom control. Carbidopa prevents peripheral conversion of levodopa, allowing more to reach the brain. It’s typically started at 25/100mg three times daily and titrated up.
Side‑Effect Comparison
All Parkinson’s drugs carry a risk of side‑effects, but they differ in frequency and severity. Below is a quick glance:
- Eldepryl: nausea, orthostatic hypotension, insomnia, headache.
- Rasagiline: similar to selegiline but lower incidence of insomnia; rare hypertension.
- Safinamide: dyskinesia (especially when combined with high‑dose levodopa), dizziness, nausea.
- Levodopa/Carbidopa: nausea, vomiting, orthostatic hypotension, and the infamous levodopa‑induced dyskinesias over long‑term use.
Choosing the right drug often hinges on which side‑effects a patient can tolerate.
Drug‑Interaction Landscape
MAO‑B inhibitors require careful diet and medication review because they can interact with sympathomimetic drugs (like decongestants) or serotonin‑modulating agents (SSRIs). Rasagiline has a lighter interaction profile than selegiline because it doesn’t produce amphetamine metabolites.
Safinamide, while also an MAO‑B blocker, has been shown to have fewer dietary restrictions, making it preferable for patients on over‑the‑counter cold remedies.
Levodopa interacts with high‑protein meals (which compete for transport across the blood‑brain barrier) and certain anti‑psychotics that block dopamine receptors.
Cost Overview in the UK (2025)
| Medication | Typical Daily Dose | Mechanism | Common Side‑effects | Approx. Annual Cost (GBP) |
|---|---|---|---|---|
| Eldepryl (Selegiline) | 5‑10mg | Selective MAO‑B inhibition | Nausea, insomnia, dizziness | £180‑£250 |
| Rasagiline | 1mg | Selective MAO‑B inhibition | Headache, mild hypertension | £300‑£350 |
| Safinamide | 100mg | MAO‑B inhibition + glutamate modulation | Dyskinesia, nausea | £420‑£480 |
| Levodopa/Carbidopa | 25/100mg × 3‑4times daily | Dopamine precursor | Nausea, dyskinesia, orthostatic hypotension | £150‑£210 |
Prices are averages and can vary by pharmacy, region, and whether the patient qualifies for NHS exemptions.
How to Choose the Right Option
There’s no one‑size‑fits‑all answer, but the following decision framework helps narrow the field:
- Stage of disease: Early‑stage patients often start with a low‑dose MAO‑B inhibitor (Eldepryl or rasagiline). Moderate to advanced patients usually need levodopa, possibly boosted by an MAO‑B inhibitor.
- Side‑effect tolerance: If insomnia is a problem, rasagiline may be preferable over selegiline. For those who develop dyskinesia on levodopa, adding safinamide can smooth out fluctuations.
- Medication burden: Once‑daily tablets (rasagiline, safinamide) reduce pill count versus the twice‑daily selegiline regimen.
- Cost considerations: Generic selegiline is the cheapest option, while safinamide carries the highest price tag.
- Drug interactions: Patients on multiple serotonergic agents should avoid selegiline due to amphetamine metabolites; rasagiline or safinamide are safer choices.
Discuss these factors with your neurologist or specialist pharmacist to craft a regimen that balances efficacy, safety, and budget.
Practical Tips for Patients Starting an MAO‑B Inhibitor
- Read labels: Avoid over‑the‑counter decongestants containing pseudoephedrine or phenylephrine.
- Monitor blood pressure: MAO‑B inhibitors can cause orthostatic drops, especially when standing up quickly.
- Take with food: Reduces nausea, a common complaint with selegiline.
- Schedule regular follow‑ups: Dose adjustments are often needed based on symptom control and side‑effects.
- Keep a symptom diary: Track “off” periods, dyskinesia, and any new side‑effects to share with your clinician.
Future Directions in MAO‑B Inhibition
Research is ongoing to develop agents that retain the dopamine‑preserving benefits while minimizing cardiovascular and psychiatric risks. Gene‑therapy approaches aim to deliver localized MAO‑B inhibition directly to the substantia nigra, potentially eliminating systemic side‑effects. While these are still experimental, they illustrate why staying informed about emerging therapies matters.
Frequently Asked Questions
Can I switch from Eldepryl to rasagiline without a washout period?
Yes. Because both drugs are selective MAO‑B inhibitors, you can transition directly under medical supervision. Your doctor may start rasagiline at 1mg while tapering selegiline over a week to avoid double inhibition.
Is selegiline safe for patients with depression?
Selegiline at Parkinson’s doses (5‑10mg) has a modest antidepressant effect because it also inhibits MAO‑A at higher concentrations. However, monitoring is essential, especially if the patient is already on antidepressants, to prevent serotonin syndrome.
Why do some patients experience dyskinesia with safinamide?
Safinamide enhances dopamine levels by blocking MAO‑B and, at higher doses, can amplify levodopa’s effect, leading to involuntary movements. Titrating the dose slowly and adjusting levodopa timing usually helps.
Do I need to follow a low‑tyramine diet with selegiline?
Unlike non‑selective MAO inhibitors, selective MAO‑B inhibitors like selegiline don’t require strict tyramine restrictions. However, avoid excessive amounts of aged cheeses and cured meats if you experience headaches.
Which medication offers the best protection against disease progression?
Evidence is mixed. Some long‑term studies suggest early MAO‑B inhibition (selegiline or rasagiline) may modestly slow progression, but definitive proof is lacking. Clinical decisions still focus on symptom control and quality of life.
Sarah Hanson
October 17, 2025 AT 21:34While selegiline remains a cost‑effective option, patients should definatly assess its insomnia profile before initiating therapy.